Provider Demographics
NPI:1417271503
Name:MAURA T O'DONNELL, MD, LLC
Entity Type:Organization
Organization Name:MAURA T O'DONNELL, MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MAURA
Authorized Official - Middle Name:TAKAO
Authorized Official - Last Name:O'DONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-354-1955
Mailing Address - Street 1:2174 HALAKAU ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96821-2604
Mailing Address - Country:US
Mailing Address - Phone:808-354-1955
Mailing Address - Fax:
Practice Address - Street 1:2174 HALAKAU ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96821-2604
Practice Address - Country:US
Practice Address - Phone:808-354-1955
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-18
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD15497208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty